冠心病的外科治疗

首例成功的冠状动脉旁路移植术（CABG）手术完成于1960年,随着体外循环技术的成熟,CABG手术得以不断发展。20世纪90年代,以非体外循环下冠脉旁路移植术（0PCAB）为代表的微创冠脉搭桥手术逐渐应用于临床,并取得满意的临床效果。尽管冠脉介入技术（PCI）以其创伤小的优点在冠心病的治疗方面蓬勃发展,但是CABG在远期通畅性方面仍然占据优势地位,因此CABG仍然是冠心病治疗的效果确定的一种方法。     

导言:冠心病的抗血小板治疗越来越重要

正众所周知,各种类型冠心病的发病、并发症的发生以及动脉硬化的进展过程都有血小板的参与,因此冠心病的抗血小板治疗已成为冠心病尤其是急性冠脉综合征治疗的基石,抗血小板治疗的重点应是急性冠脉综合征的患者[不稳定型心绞痛(UA);非ST段抬高型心肌梗死(NSTEMI);ST段抬高型心肌梗死(STEMI)]、经皮冠状动脉介入治疗(PCI)围手术期治疗、STEMI溶栓治疗的辅助治疗、冠状动脉旁路移植术(CABG)术后的治疗结合个体参照     

冠状动脉旁路移植术研究中的哲理

冠状动脉旁路移植术被广泛用来治疗冠心病及其并发症,其发展历程体现了以人为本、全面、协调、可持续的科学发展观.科学发展观属于重要的哲学思想,它从世界现和方法论的角度认识、把握和指导发展,是顺应时代潮流的发展现.分析冠状动脉旁路移植术研究所体现的科学发展观,将对准确把握冠状动脉旁路移植术发展的趋向和特点,使我国冠脉外科的发展在21世纪赶超国际先进水平起到重要的作用.     

冠心病治疗方法的比较思考

冠心病是严重影响人类健康的疾病.冠心病的治疗方法主要为:药物治疗、介入治疗及冠状动脉旁路移植术等.通过比较各种治疗方法,说明药物治疗是基础,在此基础上,合理选择介入治疗和冠状动脉旁路移植术.     

冠心病治疗方法的比较思考

冠心病是严重影响人类健康的疾病。冠心病的治疗方法主要为:药物治疗、介入治疗及冠状动脉旁路移植术等。通过比较各种治疗方法,说明药物治疗是基础,在此基础上,合理选择介入治疗和冠状动脉旁路移植术。     

对无保护左主干冠状动脉狭窄血运重建的临床决策

对于无保护左主干（LMS）狭窄的冠状动脉疾病,冠状动脉旁路移植术（CABG）一直被认为是“标准治疗”,原因就是有充分的证据证明其具有远期生存率方面的益处。但是,目前却出现了越来越多的使用药物支架而不是CABG治疗左主干狭窄的趋势,尽管目前这方面的证据还不充分。在此,本文在汇总了经皮血运重建技术（PCI）干预无保护左主干、对比支架和外科手术治疗无保护左主干的随机对照研究资料的基础上,总结认为,对于适合外科手术的无保护左主干狭窄患者,CABG仍旧是血运重建的首选。     

急性心肌梗死合并心源性休克的治疗进展

心源性休克(CS)是急性心肌梗死死亡的最主要原因。急诊再血管化治疗PCI或者冠状动脉旁路移植术(CABG)对于降低急性心肌梗死(AMI)合并CS的病死率有积极的意义。目前还没有哪个随机对照试验明确PCI或CABG哪种更好,但目前的治疗倾向于急诊PCI。合并CS的AMI患者直接多支血管PCI治疗获益增加。对于血压偏低的患者,去甲肾上腺素应该作为缩血管药物的一线选择。靶目标平均血压维持在65mmHg~70mmHg,因为更高的血压不增加临床获益。最佳的多器官功能不全综合征治疗是CS治疗的基石。经皮机械辅助装置临床应用逐渐广泛,可以提高冠状动脉的灌注,但也加剧炎症反应、出血等风险。     

老年稳定型心绞痛,药物治疗OR介入治疗

由于稳定型心绞痛的病理生理学得到阐明,心绞痛的治疗发生了改变,产生了新的治疗策略.一方面,随着新药物的发展,对心肌缺血的病理生理机制有了更深的认识;另一方面,经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)的持续快速进步也使心绞痛患者治疗有了进一步发展.与非老年人相比,老年人患稳定型心绞痛的治疗策略有其共性,亦有其特殊性,如何根据老年人血管病变特点,在以循证医学为依据的诸多指南实施中,慎重地遵循个体化原则,以使老年稳定型心绞痛患者最大获益,保障其生存质量,是目前老年心血管病研究的重点.     

稳定型冠心病患者抗血小板治疗策略

抗血小板治疗对于稳定型冠心病(SCAD)患者至关重要。如何在标准推荐治疗方案的基础上既达到抗血小板治疗的效果,又可使出血风险降到最低,需对患者冠状动脉病变特征、年龄、性别、合并症等特征进行综合考虑。本文就SCAD患者抗血小板治疗方案进行概述,包括非血运重建及血运重建SCAD患者、冠状动脉旁路移植术后患者、SCAD特殊人群的抗血小板治疗,非心脏外科手术围术期抗血小板药物调整、SCAD患者出血治疗策略等。期望本文能帮助临床医生针对SCAD患者不同情况合理应用抗血小板药,在减少血栓风险同时降低出血并发症。     

左主干合并右冠状动脉慢性阻塞性病变行PCI的有效性和安全性分析

观察左主干病变合并右冠状动脉慢性完全闭塞(CTO)的患者行个体化经皮冠状动脉介入治疗(PCI)的有效性和安全性。回顾性分析2009年1月~2014年8月,沈阳军区总医院心内科因左主干病变合并右冠状CTO病变行PCI术的患者。共入选46例患者,每位患者平均置入支架数(2.3±1.3)个,支架平均长度(29.52±6.98)mm,支架平均直径(3.61±0.42)mm。其中左主干病变行介入治疗手术成功率100%,右冠状动脉CTO病变行介入治疗手术成功率93.5%,总成功率95.7%,手术过程中无严重并发症,住院期间无急性血栓形成、无急诊冠状动脉旁路移植术(CABG)。术后心功能(左室内径、左室射血分数)较前均有改善。随访期间[平均随访时间:(14.48±15.01)个月],发生7例靶血管血运重建(其中2例CABG),主要不良心脏事件发生率15.2%。左主干病变合并右冠状动脉CTO病变采用个体化策略的冠脉介入治疗,可改善患者临床症状,同时无严重并发症发生。这提示对于左主干病变合并右冠状动脉CTO行PCI术是安全可行的。     

Language,politics and dreams: the challenges of building resilience in refugees

This paper describes a case study of a 60-year-old Peruvian refugee in some detail, focusing on the importance of building emotional resilience in a patient in Spanish in order to create a space for learning the English language – the patient did not speak English after 20 years of living in Britain. The work was carried out with an interpreter and some of the literature on working with interpreters is referred to. The paper also briefly outlines the refugee journey in broad terms, which is a journey from the culturally known to the culturally unknown. The question of how well the literature on resilience, which sits firmly within a Western developmental perspective, can be applied to refugees, most of whom come from group and family-based cultures dominated by ideas of honour and shame, is discussed. The paper also touches on the importance of the receiving country enabling or not, as the case may be, a transitional space for refugees who have lost their home and are seeking to find a safe haven in a strange culture.     

Together – apart: in touch in a time of separation

This paper explores the experience of working as a Jungian analyst through the various phases of the global COVID-19 pandemic, examining the importance of the physical containing space alongside the analyst’s internal mind and how technology can both help and hinder understanding. A number of clinical vignettes illustrate the challenge of communicating over a distance, paying particular attention to the way countertransference phenomena can become re-attuned. Reference is made to mythology and symbols of hope, and consideration given to the meaning and purpose of the pandemic.     

The Possibility of Meaning in Human Evolution

Science undermines the certitude of non-naturalistic answers to the question of whether human life has meaning. I explore whether evolution can provide a naturalistic basis for existential meaning. Using the work of philosopher Daniel Dennett and scientist Ursula Goodenough, I argue that evolution is the locus of the possibility of meaning because it has produced intentionality, the matrix of consciousness. I conclude that the question of the meaning of human life is an existentialist one: existential meaning is a product of the individual and collective tasks human beings undertake.     

Phenotypic plasticity and archetype: a response to common objections to the biological theory of archetype and instinct

Since Jung’s death in 1961, scholars have attempted to integrate growing biological science data into Jungian concepts such as the collective unconscious, instincts and the archetypes. This enterprise has been challenging due to persistent false dichotomies of gene and environment occasionally arising. Recent works by Roesler (2022a, 2022b) for example, have raised objections to the biological theory of archetypes, but the objections are plagued by such dichotomies. The concept of phenotypic plasticity, however, helps to both avoid this problem as well as bridge the gap between competing theories into a more integrated model with solid biological foundations.     

When is it time to stop? When good enough becomes bad enough

This article draws on Winnicott’s concept of the good enough mother to discuss how to know whether a therapeutic situation is good enough to continue or bad enough to end. This dilemma is explored in terms of clinical syndromes, such as anorexia and pathological gambling, but focuses mainly on analyst-initiated endings, which are termed the ‘Casablanca dilemma’, based on an amplification of the ending of the film Casablanca. The author goes on to discuss such one-sided endings, drawing on interviews with 40 analysts and therapists about their clinical experience. A typology of bad enough endings is presented. The psychological differences between a good enough analysis as opposed to a bad enough one are explored through the ideas of Winnicott and Neumann.     

The transcendent function in Spitteler’s Prometheus and Epimetheus

In August 2020, John Beebe and Steve Myers met via Zoom to discuss their differing interpretations of psychological typology and the different sources within Jung’s writings that influenced their books: Integrity in Depth: Energies and Patterns in Psychological Type (Beebe), and Myers-Briggs Typology vs Jungian Individuation (Myers). The discussion centred on Spitteler’s epic poem Prometheus und Epimetheus, which forms the basis of chapter V of Psychological Types. This is both the largest chapter and one of two chapters that Jung highlighted in the Argentine foreword as containing the essence of the book. Jung’s book is primarily about the transformation of personality rather than the categorization of people. Although it contains a critical psychology that deconstructs the nature of consciousness, that is only one half of the book and a stepping-stone to the other half, which is the reconciliation of opposites with particular emphasis on the relation of consciousness and the unconscious. Jung assumed that readers were already familiar with Prometheus und Epimetheus, an understanding of which sheds light on the nature of the transformation that Jung described – the development of a new attitude towards attitude itself.     

Kann Es Ein Argument Für Den Skeptizismus Geben? Das Epistemische Problem Der Irrtumsmöglichkeit

Summary  Is there any argument for scepticism? The epistemic problem of the possibility of error. Arguments for scepticism rest on the assumption that knowledge claims are fallible. For this reason the concept of knowledge appears to be questionable. Since it is necessary to distinguish doubts from possible doubts, the arguments for scepticism appear to be unconvincing. If we take it into account that we know something that is immune to doubt, we should draw the conclusion that, contrary to scepticism, knowledge claims have to be compatible with being fallible. Thus any knowledge claim is capable of being doubted.     

Seeing in the Dark: A View into Dissociation and Healing

In this paper, I will explore the role of art-making, the experience of trauma and dissociation, and the process of working with self-states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched’s (2013) recommendation for a “binocular stance” to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client’s unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth.     

Chapter 6: Biblical Foundations for a Practical Theology of Aging

SUMMARY

This article reviews Biblical sources pertaining to the elderly, particularly the frail elderly. Founded on these sources, implications for elderly with Alzheimer's Disease and other forms of dementia are addressed through a personal perspective informed by writings of Christian mystics.